Twenty-Year Analysis of Autologous Support of the Pulmonary Autograft in the Ross Procedure
Twenty-Year Analysis of Autologous Support of the Pulmonary Autograft in the Ross Procedure
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DOI：
10.1016/j.athoracsur.2013.04.019
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发表时间：
2013-09-01
影响因子：
4.6
通讯作者：
Tatoulis, James
中科院分区：
文献类型：
--
作者：
Skillington, Peter D.;Mokhles, M. Mostafa;Tatoulis, James
背景资料。ROSS手术很少提供给60岁以下需要主动脉瓣置换的成年人，除非是在少数有文件证明的专业知识的大容量中心。植入自体肺移植物作为无支架的根部置换，可能会导致在第二个十年内增加对主动脉瓣的再手术。在1992年10月至2012年6月期间接受Ross手术的333例患者中，研究组连续310例患者(平均年龄+/-标准差，39.3+/-12.7岁(范围16-63岁))调整了主动脉根部大小，以匹配作为根部置入的自体肺移植物，并在其周围关闭主动脉以提供自体支持。平均随访时间为9.4年；16年的精算存活率为97%；5年后无再手术和晚期超声心动图发现的主动脉瓣返流超过轻度的比例分别为95%、94%和93%。总的主动脉瓣和肺动脉瓣再手术5年、10年和15年的生存率分别为97%、94%和93%。所有结果对于以主动脉狭窄为主要表现的患者(15年时有98%的自由度)都好于那些有主动脉瓣关闭不全的患者(p=0.01)。自体肺移植物的支持在表现为主动脉狭窄和混合性主动脉狭窄/反流的患者中具有良好的效果，对于表现为单纯的主动脉瓣反流的患者也具有良好的效果。应该考虑更广泛地采用Ross手术，它使用的是一种经过验证的、持久的可用技术。(C)2013年，由胸外科医生学会主办
Background. The Ross procedure is seldom offered to adults less than 60 years of age who require aortic valve replacement except in a few high-volume centers with documented expertise. Inserting the pulmonary autograft as an unsupported root replacement may lead to increasing reoperations on the aortic valve in the second decade.Methods. Of 333 patients undergoing the Ross procedure between October 1992 and June 2012, the study group of 310 consecutive patients (mean age +/- standard deviation, 39.3 +/- 12.7 years (limits 16-63) had the aortic root size adjusted to match the pulmonary autograft, which was inserted as a root replacement, with the aorta closed up around it to provide autologous support.Results. The mean follow-up time was 9.4 years; the actuarial survival was 97% at 16 years; and freedom from the composite of all reoperations on the aortic valve and late echocardiographic-detected aortic regurgitation greater than mild was 95% at 5 years, 94% at 10 years, and 93% at 15 years. Overall freedom from all reoperations on aortic and pulmonary valves was 97% at 5 years, 94% at 10 years, and 93% at 15 years. All results were better for the patients presenting with predominant aortic stenosis (98% freedom at 15 years) than for those with aortic regurgitation (p = 0.01).Conclusions. Autologous support of the pulmonary autograft leads to excellent results in the groups presenting with aortic stenosis and mixed aortic stenosis/regurgitation and to good results for those presenting with pure aortic regurgitation. The Ross procedure, using one of the proven, durable techniques available, should be considered for more widespread adoption. (C) 2013 by The Society of Thoracic Surgeons